Transcript Value Options Summit VO Template March 23 MG

Behavioral Health: The Link to
Individual and Organizational
Wellness
Mark S. Gold, MD
Distinguished Professor & Chairman
Department of Psychiatry
University of Florida
March 26 & 31, 2009
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Agenda
• Discuss how mental health and substance abuse
issues can negatively affect the workplace
• Learn about the importance of exercise in mood
maintenance, recovery, and resilience
• Gain strategies to promote understanding of mental
health issues, drug addictions, interventions and
treatment
• Enhance your company’s ability to support
employees with regard to behavioral health issues
and improve the bottom line
2
U.S. Life Expectancy Ranking
Drops
 U.S. has dropped from 11th to 42nd place, over 20
years, in the world ratings for life expectancy
 Why? Expensive health insurance, rising infant
mortality rates and an ever-increasing rate of obesity
 Alcohol/drug related accidents cause most of
premature deaths
 More than 25% of babies are born after exposure to
tobacco, alcohol, and drugs
 The decline reflects the disparity in wealth:
 The life expectancy of African Americans is 73.3 compared with
77.9 for whites.
 For African-American males, it is even shorter: 69.8.
 Nearly 1/3 of U.S. adults are obese
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50% of Deaths in U.S.
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Tobacco
Lack of exercise, obesity
Alcohol
E.T.S.
Drugs, alcohol, accidents and suicide
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Causes of Death in the U.S.
Actual Cause
No. (%) in 1990
No. (%) in 2000
Tobacco
400,000 (19)
435,000 (18.1)
Poor diet / inactivity
300,000 (14)
400,000 (16.6)
Alcohol consumption
100,000 (5)
85,000 (3.5)
Microbial agents
90,000 (4)
75,000 (3.1)
Toxic agents
60,000 (3)
55,000 (2.3)
Motor vehicle
25,000 (1)
43,000 (1.8)
Firearms
35,000 (2)
29,000 (1.2)
Sexual behavior
30,000 (1)
20,000 (0.8)
Illicit drug use
20,000 (1)
17,000 (0.7)
Total
1,060,000 (50)
1,159,000 (48.2)
Mokdad et al., JAMA 2004
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6
MSG
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Source of Secondhand Exposure
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•
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Air
Exposed skin
Hands
Head-hair
Nov. 4, 2002
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Michael Phelps
The swimmer,
who won a
record eight gold
medals at the
Beijing Games,
did not dispute
the authenticity
of the picture:
“I engaged in
behavior which
was regrettable
and
demonstrated
bad judgment,”
Phelps said.
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10
MSG
10
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
6.00%
1981
7.00%
1980
1979
1978
1977
1976
AVERAGE POTENCY OF TESTED SAMPLES
(AMOUNT-WEIGHTED)
AVERAGE POTENCY OF TESTED CANNABIS SAMPLES
9.00%
8.00%
SEIZURES
DOMESTIC ERADICATION
ALL SAMPLES
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
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Proportional Contribution to
Premature Death
NEJM 357(12): 1222; 2007
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Cocaine Positivity by Zip Code,
2006
13
Effects of Drug Abuse
Cocaine Deaths in the State of Florida
2500
2000
1500
1000
500
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
0
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Anhedonia and Abstinence
• Drugs produce sense of well-being and euphoria
• Drugs of abuse change the brains set point for
reward and pleasure
• Drug withdrawal produces depression and
anhedonia
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Annual Numbers of New Non-medical
Users of Pain Relievers: USA, 1965-2002
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Health Consequences
• Tobacco
– 12 million deaths over past 40 years
– 30% of cancer & heart disease deaths
– linked to other substance abuse, mental
illness in teens
• Alcohol
– linked to liver disease, cancers,
unintentional accidents / mortality, suicide,
co-occurring mental health disorders
• Illicit drugs
– 16,000 deaths annually
– risk of teen depression, conduct problems
and death from homicide, suicide, accidents,
illness
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Total Cost of Addiction to
Society, 2007: $647.6 Billion
Illicit Drugs
$209.7 billion
Alcohol
$236.5 billion
Tobacco
$201.4 billion
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Comparative Costs, Spending,
& Prevalence
Substance Costs to
NIH
Society Spending
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Prevalence
AOD
Cancer
$446B
$219B
1.5B
5.5B
22 million
10 million
Tobacco
Diabetes
Depression
HIV
$201B
$154B
$100B
$ 40B
0.5B
1.0B
0.4B
3.0B
25 million
16 million
19 million
0.44 million
U.S. Drug-Related Emergency
Department Visits by Adults
Increased Significantly Since 1995
10%
8%
7.0%
6%
5.0%
3.7% *
4%
2.7% *
2%
0.6%
0%
5.5%
*
1995
2000
2005
Drug-Related Visits
1995
2000
2005
Alcohol-Related Visits
Adapted by CESAR from Cherpitel, C.J. and Ye, Y. “Trends in Alcohol- and DrugRelated ED and Primary Care Visits: Data from Three U.S. National Surveys
(1995-2005),” The American Journal of Drug and Alcohol Abuse 34(5):576-583,
2008.
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Drug Abuse Is a “Treatable Disease”
NIH/NIDA
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Huge Public Health
Problem
MDs are out of the loop (Penn Addiction
Referral Sources)
Source of Addiction Referrals
1990
2004
Criminal justice
38%
59%
Employers/EAP
10%
6%
Welfare/CPS
8%
16%
Hospitals/physicians
4%
3%
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MSG
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Depression and Smoking
“Bridget Jones’s Diary”
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What’s Making Us So Fat?
•
•
Genetics
Access to
fattening
foods:
–
–
•
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increase in
fast-food
restaurants
high-calorie
corn syrup
consumptio
n
Result? The
population of
obese U.S.
adults has
grown 50%
since the
1970s
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Did You Know …
… that
Marilyn Monroe
was 5’5” tall
and
weighed a
healthy
135 pounds
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Did You Know …
… that
most
fashion
models are
thinner
than 98%
of
American
women
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The Fattening of America …
Employers Are Concerned
• Men who carry
around extra fat cost
their employers $170
more in medical
expenses
• Overweight women
ring up $495 more in
doctor bills
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employees $285,000 a year, 30% of which is from missed
workdays
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Percentage of Adult Obesity
•
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Mississippi is No. 1 in obesity: 31.7%
• Change over last year: up 1.1 points
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Obesity Treatment Pyramid
Surgery
Pharmacotherapy
Lifestyle
Modification
Diet
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Physical Activity
Estimated Number of Bariatric Operations
Performed in the United States, 1992-2003
Steinbrook, R. N Engl J Med 2004;350:1075-1079
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Depressed and Stressed
 Self-medication hypothesis
• Some patients report food is
comforting in times of stress
• When offered a more palatable
diet, most animal species eat
more and become obese.
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Impact of Weight Loss on Risk
Factors
~5%
Weight Loss
HbA1c
1
1
Blood Pressure
2
2
Total Cholesterol
3
3
HDL Cholesterol
3
3
Triglycerides
1. Wing RR et al. Arch Intern Med. 1987;147:1749-1753.
2. Mertens IL, Van Gaal LF. Obes Res. 2000;8:270-278.
3. Blackburn G. Obes Res. 1995;3 (Suppl 2):211S-216S.
4. Ditschunheit HH et al. Eur J Clin Nutr. 2002;56:264-270.
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5%-10%
Weight Loss
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Four Health Behaviors Can
Add 14 Extra Years of Life
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•
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Not smoking
Taking exercise
Moderate alcohol intake
Eating five servings of fruit and
vegetables a day
Source: Khaw KT, Wareham N, Bingham S, Welch A, Luben R, et al. (2008) Combined impact of health
behaviours and mortality in men and women: the EPIC-Norfolk Prospective Population study. PLoS
Med 5(1): e12.
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Impact of Weight Loss on
Health
5% - 10% weight loss =
• improved symptoms of arthritis
• improved mobility and physical endurance
• improved blood pressure
• improved cholesterol
• 20%+ reduction in total mortality
• 30%+ reduction in diabetes-related deaths
• 40%+ reduction in obesity-related cancer deaths
Source: National Heart, Lung, Blood Institute
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Complex Multi-Factorial
Environment
Drive Time
City Planning
Society Mores
Ethnicity
Cultural
Income
Education
Psychological
and
Behavioral
Physical Activity
Metabolic
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Genetics
Food
Taste Preference
Processed Foods
Lifestyle
Sleeplessness Is Up, as the
Economy Is Down
• Some 70 million Americans suffer from a
chronic sleep disorder or intermittent sleep
problem
• Women have the problems more often than
men
• Sleep difficulties increase with age
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Sleeplessness Is Up, as the
Economy Is Down (cont.)
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Other findings in the poll:
46 percent said their sleep needs aren't being met
35 percent sleep less than six hours a night
Consequences of sleep deficit:
– 41 percent have driven while sleepy
– Almost 1/3 said that lack of sleep affected their
work
– 1/3 said lack of sleep caused emotional
problems, such as anxiety and depression
• Sleep disorders reported:
– 89 percent reported insomnia
– 33 percent reported restless leg syndrome
– 14 percent reported sleep apnea
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Costs in Dollars
 Like butter and sugar, obesity has a cost per pound
 The annual per-pound cost of being overweight is $19.39.
 For 25-year-olds, it averages $10.25 for every overweight
pound.
 By age 64, it increases to $26.32.
 (On average, overweight people are 29 pounds overweight;
the obese are 82 pounds overweight.)
 Added annual health care costs:
 For someone age 25:
 $209 for the overweight
 $960 for the obese
 By age 64:
 $610 for the overweight
 $2,300 for the obese
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Elements of Successful (MD )Treatment—
Apply to All Chronic Disease Management
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Active involvement of coach or manager
Contingency management
Frequent random drug testing
A.A. and abstinence orientation
Active management of relapse and intensified
treatment in response
Long-term, 5-year plus, continuing care approach
Include diet
Include exercise
Include stress-/self-management
Focus on lifelong recovery
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Resources
• Dr. Gold
http://www.psychiatry.ufl.edu/faculty/gold-mainshort.shtml
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